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The Effectiveness of Prophylactic Modified Neck Dissection for Reducing the Development of Lymph Node Recurrence of Papillary Thyroid Carcinoma.

ABSTRACT: The most frequent recurrence site of papillary thyroid carcinoma (PTC) is the cervical lymph nodes. The introduction of an electric linear probe for use with ultrasonography in 1996 improved preoperative lateral neck evaluations. Before 2006, however, our hospital routinely performed prophylactic modified neck dissection (p-MND) for N0 or N1a PTCs >1 cm to prevent node recurrence. In 2006, we changed our policy and the indications for p-MND to PTCs >3 cm and/or with significant extrathyroid extension. Here, we retrospectively compared lymph node recurrence-free survival between PTCs with/without p-MND.We examined the cases of N0 or N1 and M0 PTC patients who underwent initial surgery in 1992-2012. To compare lymph node recurrence-free survival between patients who did/did not undergo p-MND, we divided these patients into three groups (excluding those whose surgery was in 2006): the 2045 patients whose surgery was performed in 1992-1996 (Group 1), the 2989 with surgery between 1997 (post-introduction of ultrasound electric linear probes) and 2005 (Group 2), and the 5332 operated on in 2007-2012 (Group 3).The p-MND performance rate of Group 3 (9%) was much lower than that of Group 1 (80%), but the lymph node recurrence-free survival of the former was significantly better, probably due to differences in clinical features and neck evaluations by ultrasound between the two groups. Our analysis of the patients aged <75 years with 1.1-4-cm PTCs in Groups 2 and 3 showed that p-MND did not improve lymph node recurrence-free survival. p-MND did significantly improve lymph node recurrence-free survival for the extrathyroid extension-positive 3.1-4-cm PTCs, but not for the other subsets.Abolishing routine p-MND for PTCs in 2006 did not decrease lymph node recurrence-free survival, probably due to improved ultrasound preoperative neck evaluations and clinical feature changes. Selective p-MND for high-risk cases improved lymph node recurrence-free survival.

SUBMITTER: Ito Y

PROVIDER: S-EPMC5544793 | biostudies-other | 2017 Sep

REPOSITORIES: biostudies-other

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Project description:BackgroundIt remains controversial whether prophylactic central compartment neck dissection (pCCND) is necessary in cases of stage T1-T2 cN0 papillary thyroid carcinoma (PTC). Some studies have demonstrated the benefits of pCCND on oncologic outcomes, whereas others reported that any advantages were insignificant. The purpose of this study was to investigate the effects of pCCND on cancer recurrence and its pattern in patients with T1-T2 cN0 PTC.MethodsWe retrospectively reviewed 2,902 patients with PTC who had undergone thyroidectomy between 2006 and 2012 at Seoul St. Mary's Hospital: 2,099 patients had undergone pCCND and thyroidectomy (pCCND group), whereas 803 did not undergo pCCND (non-pCCND group). We investigated the effects of pCCND on cancer recurrence by comparing these two groups. Recurrence was classified according to the location of the recurrence.ResultsThe mean follow-up period was 112 months. The mean patient age was significantly younger in the pCCND group than in the non-pCCND group. There were no statistically significant differences in the distribution of sex, tumor size, or thyroidectomy extension between the groups. In the pCCND group, 883 (42%) patients showed evidence of N1a disease, and the mean number of metastatic lymph nodes was 1.26±2.2. Recurrence occurred in 67 (2.3%) patients in the total cohort. Recurrence was observed in 20 (2.5%) and 47 (2.2%) patients in the non-pCCND and pCCND groups, respectively, but there were no significant differences between the groups (P=0.687). When analyzed by the site of recurrence, 50% and 4.3% of recurrent disease in the non-pCCND and pCCND groups, respectively, occurred in the central compartment (P<0.001). There were no differences between the two groups in recurrent disease at other sites. The 15-year cumulative central compartment recurrence-free survival (RFS) rates of patients in the non-pCCND and pCCND groups were 99% and 100%, respectively (P<0.001). In the multivariate analysis, not performing pCCND was the only independent risk factor related to central compartment RFS, and the hazard ratio was 13.362 [95% confidence interval (CI): 2.928-60.986; P<0.001].ConclusionsThe omission of pCCND was found to be an independent risk factor for recurrence in the central compartment in patients with T1-T2 cN0 PTC.

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The Effectiveness of Prophylactic Modified Neck Dissection for Reducing the Development of Lymph Node Recurrence of Papillary Thyroid Carcinoma.

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